North House Surgery

Updated 31 May 2017

North House Surgery, North Street, Ripon, HG4 1HL is a member of Harrogate and Rural District Clinical Commissioning Group (CCG). It is situated in a semi-rural location and serves Ripon and the surrounding villages. The registered list size is approximately 8,900 who are predominantly of white British background. The age profile differs from the England average with there being a higher number of patients in the 60 to 79 age range and a lower number in the 20 to 39 age range.

The practice is ranked in the ninth least deprived decile (one being the most deprived and 10 being the least deprived).

The practice is run by four partners, one full time and three part-time (one male and three female) and four salaried GPs (all female). Other clinicians consist of an advanced nurse practitioner, a nursing team manager, two practices nurses, a health care assistant and a phlebotomist. The clinicians are supported by a business manager and an experienced practice support team consisting of administration and reception staff.

North House Surgery is a dispensing practice and employs a dispensing team leader and three dispensers. The practice dispenses to approximately 29% of their patients. They also receive additional pharmacy support from the local CCG medicines management team.

The practice is open from 8am to 6.30pm Monday to Friday with extended opening hours available on a Tuesday until 8pm. The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Harrogate District Foundation Trust (the contracted out-of-hours provider) via the 111 service.

North House Surgery is a teaching practice. They are accredited to train qualified doctors to become GPs (registrars) and to support undergraduate medical students with clinical practice and theory teaching sessions.

The practice holds a Personal Medical Services (PMS) contract to provide GP services which is commissioned by NHS England.

The previous inspection ratings were noted as being available to patients both in the practice and on their website.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of North House Surgery on 10 October 2016. The overall rating for the practice was good. However, a breach of legal requirements was found, resulting in a rating of requires improvement for the safe domain. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for North House Surgery on our website at www.cqc.org.uk.

On 16 May 2017, we undertook an announced focused inspection. This was to confirm that the practice had carried out their plan to meet the legal requirements, in relation to the breaches in regulations that had been identified at our previous inspection on 10 October 2016. This report covers our findings regarding those requirements and any additional improvements that have been made since our last inspection.

Our key findings were as follows:

• There were up to date and version controlled standard operating procedures in place to support staff working within the dispensary at the practice.
• All repeat prescriptions were signed by a GP before medicines were dispensed.
• There was a revised system in place to review those patients who were on repeat medication, or high risk medicines, prior to dispensing.
• Processes had been implemented in the dispensary to record near misses.
• The dispensing lead had initiated quarterly meetings with dispensing staff; there was a set agenda and minutes of the meetings were to be taken.
• There was a system in place for tracking and recording blank prescription forms within the practice.
• Patient Group Directives (PGDs) were in date and signed.
• There were records of when checks were carried out in relation to vaccine refrigerator temperatures.
• The practice had emergency ‘grab bags’ of medicines for GPs to take on home visits. These were kept alongside other emergency equipment within the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 November 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for the five diabetes related indicators was higher than the national average. For example the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 92% compared to the national average of 88%.Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. For example a consultant and diabetic specialist nurse visited the practice every three to four months and worked together with the practice’s Chronic Disease Nurse to consult with those patients that needed additional assistance to control their blood sugar levels.

Updated 28 November 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Childhood immunisation rates for the vaccinations given were high when compared to the England average for under two year olds and lower for five year olds. For example childhood immunisation rates for the vaccinations given to under two year olds ranged from 88% to 100% compared to the England average of 73% to 95% and five year olds from 78% to 97% compared to the England average of 81% to 95%.Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 79% and higher than the national average of 74%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 28 November 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 28 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 28 November 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

Performance for the three mental health related indicators was slightly higher than the national average. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 91% compared to the national average of 88%. The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 87% compared to the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example the practice met with a Consultant Psychiatrist every six months to discuss the care and treatment of certain patients with mental ill health.

• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• A counsellor worked out of the practice once a week which GPs could refer patients to.
• A local Drug and Alcohol Dependency Scheme offered a weekly clinic at the practice.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice held a dedicated patient annual health review clinic at the practice for a local residential home for younger visually impaired adults.
• As part of the local nursing home enhanced scheme a GP from the practice carried out a scheduled visit to each of three nursing homes they supported every two to four weeks.
• The practice had offered their services when approached by the CCG to register refugees’ families and to support them with their transition in their new environment. The practice would be commencing this work imminently.